Provider Demographics
NPI:1649843079
Name:DESERT SKY HOLDINGS LLC
Entity type:Organization
Organization Name:DESERT SKY HOLDINGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PAZARENZOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-517-6392
Mailing Address - Street 1:5601 COLLEYVILLE BLVD STE 17
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-6022
Mailing Address - Country:US
Mailing Address - Phone:512-517-6392
Mailing Address - Fax:
Practice Address - Street 1:5601 COLLEYVILLE BLVD STE 17
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6022
Practice Address - Country:US
Practice Address - Phone:512-517-6392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-22
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care